Democrats promoting the Biden administration’s health care achievements at their convention in Chicago this week have mostly dropped appeals for a policy that split the party during Vice President Kamala Harris’s first presidential campaign: Medicare for All.
Ms. Harris, who proposed a less sweeping plan in 2019 than some of her progressive rivals, no longer supports a single-payer health insurance system, her campaign said last month.
Her avoidance of a policy that had been central to progressive Democratic aspirations underscores how quickly she has sought to define her candidacy while appealing to more moderate voters, and how Medicare for All proposals have effectively left the Democratic mainstream for now.
It also represents more broadly how the prospects for Medicare for All legislation have dimmed during President Biden’s term, forcing progressive Democrats to reassess their strategy in a difficult political climate.
Mr. Biden did not support Medicare for All proposals in his 2020 campaign or as president. Instead, he pursued a more traditional set of health care priorities, such as increasing enrollment in Medicaid and the Affordable Care Act’s marketplaces.
Even if Democrats were to win control of the Senate and the House, they would be unlikely to have a large enough margin to pass legislation like Medicare for All.
That has not mattered to Republicans, who have continued to suggest that Ms. Harris would pursue a more radical position as president than she is letting on in her campaign. Former President Donald J. Trump said last week that a win by Ms. Harris would mean Americans being forced into a “communist system” in which “everybody gets health care.”
Progressive Democrats are still hoping to see a resurgence years from now. They have argued that Mr. Biden’s agenda amounts to a kind of intermediate victory in service of the long game. Senator Edward J. Markey, Democrat of Massachusetts and a proponent of Medicare for All, said the Biden administration’s efforts to grow Medicaid, eliminate medical debt and allow Medicare to negotiate drug prices captured the spirit of universal health coverage.
“I am heartened that the DNA of Medicare for All is in the health care policies that the Biden administration has supported and that Vice President Harris supports,” he said.
But it has become less of a talking point for Democrats. The Congressional Progressive Caucus this year left Medicare for All out of its policy agenda for 2025, a signal that the issue was likely to take a back seat to other health policy goals.
Representative Pramila Jayapal, a Washington Democrat who is the chairwoman of the caucus and the lead sponsor of a House version of Medicare for All legislation, said the omission was not a call to drop Medicare for All legislation from the group’s goals.
Those include some piecemeal policies included in the fuller Medicare for All bill, such as expanding the program to pay for dental, vision and hearing services, something the Democratic Party platform adopted this week and said would be funded “by making the wealthy and big corporations pay their fair share.”
“These are things we could pass on Day 1,” Ms. Jayapal said. “We’re just being real that we don’t have the votes to pass Medicare for All on Day 1. We have to do more work to make it happen.”
Senator Bernie Sanders, the Vermont independent who served as a kind of pacesetter among Democratic candidates in 2019 with Medicare for All proposals, said in an interview that he would press on with the version of a bill he introduced again last year. The first Medicare for All legislation he introduced in 2007 had no co-sponsors, he noted. Now, about 15 senators have endorsed his most recent version of the bill.
Ms. Harris initially cosponsored Mr. Sanders’s legislation in 2017, when she was serving in the Senate.
Ms. Jayapal said that support in the House had crept up to about 115 Democrats, or more than half the caucus. Around a dozen top-ranking Democrats on committees supported the bill, she added.
“Are we making progress? Yes,” Mr. Sanders said.
Health policy experts said that changes in Medicare, Medicaid and the Affordable Care Act’s marketplaces, some of them key Democratic policy goals, have complicated efforts to pursue Medicare for All legislation. The national uninsured rate reached a record low of about 7 percent last year, according to survey data from the Centers for Disease Control and Prevention, a trend partly attributable to the explosive growth of the Affordable Care Act, which uses private insurance companies.
Around 21 million people signed up for Affordable Care Act plans this year, a record, and millions more secured coverage through the law’s provision allowing states to expand the Medicaid program to cover more adults. Medicaid plans are largely run by private health insurance companies.
Many states have drastically lowered their uninsured rates with help from those provisions. Some have achieved levels that approach universal coverage: In 2022, nine states and the District of Columbia had uninsured rates below 5 percent.
More than half the eligible Medicare population — about 33 million people — is enrolled this year in a private Medicare Advantage plan, another feature that would make the implementation of a single-payer health insurance system challenging. Researchers estimate that nearly two-thirds of the Medicare population will have a Medicare Advantage plan by 2034.
The private health sector “really benefits from the system as it stands,” Ms. Jayapal said. “And to change it would take a lot of alignment in the Democratic Party.”
As a presidential candidate in 2019, Ms. Harris argued that there should be a role for private plans in a Medicare for All system, an idea modeled on Medicare Advantage. In her goals for reshaping Medicare, she proposed a version of a so-called public option, or a government-run plan that would compete with private insurers. Mr. Biden has supported a public option, but he and Democratic lawmakers have not moved to implement one.
Some states have pursued public options on their own.
Without the votes to pass Medicare for All legislation, some lawmakers have devised alternatives. Mr. Markey last month introduced legislation that would allow states to provide universal coverage for state residents. That strategy would mimic the state’s 2006 health law that served as a model for Obamacare, Mr. Markey said.
“It took Massachusetts to pass the Affordable Care Act,” he said.
“All issues go through three phases: political education, political activation, political implementation,” Mr. Markey said. “So we will have to continue the process.”
Mr. Sanders cited recent polling from Data for Progress, a left-leaning polling firm, showing majority support among likely battleground state voters for Medicare for All. There has been inconsistent polling from other groups. KFF, a nonprofit health policy research group that produces regular, heavily cited surveys, has not conducted a poll on Medicare for All support since 2020.
“We have not polled recently on Medicare for All because there hasn’t been debate about it,” said Drew Altman, KFF’s president.
Health policy experts and pollsters said Ms. Harris was benefiting from avoiding a primary that might have encouraged her to take more progressive health policy positions less suited to a general election campaign. “You get into detailed policy discussions during primaries,” said Adrianna McIntyre, a health policy expert at the Harvard T.H. Chan School of Public Health.
Mr. Sanders dismissed the Harris campaign’s stance, saying it reflected her existing position in the Biden administration, not a profound shift in Democratic Party priorities. “Why would that be a surprise?” he said.
“We will do everything we can to lobby hopefully President Harris and the congressional leadership to move in that direction,” Mr. Sanders said. “But at the end of the day, the most important thing we can do is rally tens of millions of people.”